Provider Demographics
NPI:1306571559
Name:GALBREATH, MIRANDA L (MA, MA, LPC)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:L
Last Name:GALBREATH
Suffix:
Gender:F
Credentials:MA, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W 31ST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1742
Mailing Address - Country:US
Mailing Address - Phone:240-687-2414
Mailing Address - Fax:
Practice Address - Street 1:2230 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4545
Practice Address - Country:US
Practice Address - Phone:833-487-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty